The objective of this study was to investigate the relationship between anxiety personality trait, Quality of Life (QoL) and severity of disease in a Greek population of patients with Chronic Heart Failure (CHF).

Twenty-seven consecutive CHF outpatients (22 males, 5 females; age: 56±12) were asked to answer the Greek version of the Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI), as a part of a thorough cardiological and psychiatric clinical evaluation. QoL was assessed with the Greek version of the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). Multiple linear regression was conducted to determine the best linear combination of Trait Anxiety scores and severity of disease scores, for predicting KCCQ Overall Summary Score. The indices of disease severity that were used were New York Heart Association (NYHA) class in the first model and VO2peak in the second model.

For the first model (adjusted R2=0.557, F(2,20)=14.816, p< 0.001), NYHA class (B=-8.430, SE=3.965, beta=-0.323, p< 0.05) as well as Trait Anxiety (B=-0.886, SE=0.225, beta=-0.597, p< 0.05) significantly predict KCCQ Overall Summary Score.

For the second model (adjusted R2=0.616, F(2,19)=17.848, p< 0.001), VO2peak (B=17.998, SE=8.374, beta=0.317, p< 0.05) as well as Trait Anxiety (B=-0.884, SE=0.208, beta=-0.626, p< 0.001) significantly predict KCCQ Overall Summary Score.

Trait Anxiety predicts QoL independently of disease severity in CHF and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation.

To illustrate, with a case report, the risk of suicide in general hospitals among inpatients with acute confusion or delirious states.

The review of a patient record who represents an instance of this risk is reported.

A Brazilian farmer, with incomplete elementary education, was admitted to the General Infirmary of Adults, from the Clinical Hospital of the State University of Campinas-Brazil (Unicamp), diagnosed with a hypothyroidism mixedematous myopathy, which led to the following clinical sequence: rhabdomyolysis, myoglobinuria and acute renal failure. An accidental iatrogenic levothyroxine poisoning precipitated or exacerbated the confusion in this previously weakened patient, leading to psychiatric symptoms of delirium. When a bed was brought to the corridor by nurses, he considered it an ambush. Anxious, wanting to flee, he pitched himself from the 6th floor (8 meters). The fall was partly contained by a protection net. Following the episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes.

Physicians should recognize confused states to identify and treat the underlying causes and to prevent the development of its complications. Besides clinical and psychiatric care for patients with confused and agitated states, several other measures are recommended when aiming to prevent suicide in a general hospital, such as: restriction of access to means of suicide (windows and hazardous balconies); placement of protective nets; training of the care team for early detection and intervention in any mental disorders; assessment of suicide risks before hospital discharge.

To exemplify the role and relationship of Consultation Liaison Psychiatry with other areas of knowledge involved in the health-disease process, intending to propose solutions, under a biopsychosocial perspective, to clinical (care delivery) or institutional (service-related) problems.

The review of a patient record who represents an instance of this need for integration of approaches is reported.

The case of a patient who presented an unusual pathophysiological manifestation of Behçet's Syndrome (pseudo tumor neurological inflammation) and also developed psychiatric manic symptoms after the pharmacological treatment with corticosteroids is described. Despite both the remission of mental and behavioral symptoms with psychopharmacological treatment of short duration, her clinical outcome made it necessary to reintroduce corticotherapy, with recrudescence of psychiatric manifestations and the need for maintenance treatment to assure its management.

Besides illustrating a rare clinical condition, the described report exemplifies the benefits of joint and planned actions between psychiatrists and other professionals involved in integral assistance to inpatients at hospital wards.

End stage renal disease (ESRD) is a chronic disease that shortens the life span of individuals. Renal transplantation is accepted as good choice in the treatment of patients with ESRD. Many physical, psychological and social problems have been observed for many years in receivers after renal transplantation. The problems encountered after renal transplantation may adversely affect the life quality of the individuals. This study is carried out to define the life quality of the receivers after a year of renal transplantation.

54 patients that were followed in a transplantation centre of a university hospital between January 2007 and January 2009 were included into the study. The data is obtained through personal data forms and SF-36 life quality scale.

It was defined meaningful negative relation between the age and life quality of the receivers was found (p< 0.00), as the age increases the life quality of the receivers decreased, the life quality of women receivers and the ones living in large families was found to be lower.

The life quality of the receivers after a year of transplantation was good in low level. It is necessary that the receivers be cared with holistic approach and supported them to have quality life considering life quality of the individuals.

This study is realized as a descriptive study in order to investigate the fatigue, anxiety and depression in cancer patients.

The study was conducted on 80 patients who stay in an oncology hospital between 1st of February and 31st of July 2009 with the diagnosis of the cancer. The data of the study was collected with personal information form (PIF), Cancer Fatigue Scale (CFS) and Hospital Anxiety and Depression Scale (HADS).

A positive significant relation was determined between fatigue, anxiety and depression levels of the patients (p< 0.05). As the fatigue increased, anxiety and depression also increased. It was determined that there was a negative significant relation between hemoglobin level and fatigue, anxiety, depression. As the hemoglobin level decreased, fatigue, anxiety and depression increased. The level of fatigue, anxiety and depression was higher in female patients. Patients who have another disease and indicated that the disease hinders the activities of daily living had a higher level of physical ad cognitive fatigue. Literate patients had high level of physical, emotional, cognitive fatigue and depression; patients who are high school graduates had higher levels of emotional fatigue.

There is a close relationship between fatigue, anxiety and depression in cancer patients. As the fatigue increases, anxiety and depression also increase. Convenient attempts should be planned in order to evaluate the case of fatigue, anxiety and depression comprehensively in treatment and care process of the cancer patients.

Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet. The present study aims to assess alexithymia, hypochondriasis and obsessive-compulsive symptoms in patients with chronic prostatitis.

Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated for the presence of alexithymia, hypochondriasis and obsessive compulsive symptoms using respectively the following psychometric tools: Toronto Alexithymia Scale (TAS), Whiteley Index (WI) and Leyton Obsessional Inventory (LOI). Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.

57 patients (median age 40 yrs old; IQR 32-51.5 yrs) have been evaluated so far. Median CPSI score was 18 (IQR: 13-24). Median TAS score was 44 (39-57), median LOI score was 13 (10-15) and median WI score was 28 (22-38). An abnormal LOI score indicative of obsessive-compulsive features was noted in 58% of patients and an abnormal WI score indicative of hypochondriacal beliefs in 45%. CPSI strongly correlated with TAS score (r=0.57, p=0.007).

High rates of alexithymia, obsessive compulsive symptoms and hypochondriasis are present in chronic prostatitis patients. Alexithymic features were strongly correlated with quality of life measures such as the CPSI. These findings necessitate further elucidation and suggest that patients with chronic prostatitis may need psychiatric counseling and therapy.

Chronic kidney disease (CKD) has profound effects on the quality of life (QoL) of patients with serious mental health, physiological, and socio-economic implications. The co-occurrence of inflammation and protein-energy wasting in patients with CKD (called the Malnutrition-Inflammation Complex Syndrome (MICS)) is known to be associated with adverse medical outcomes and increased mortality. We designed this study to examine the relationship between nutritional and inflammational status and QoL in patients with kidney transplant.

Data from 100 randomly selected patients were analyzed in a cross-sectional survey. Socio-demographic parameters, laboratory results, transplantation related anamnestic data, co-morbidities and medication were tabulated at baseline. MICS was assessed with a recently developed scoring system (Malnutrition Inflammation Score - MIS). Health related quality of life (HRQOL) was assessed with the KDQOL-SFTM questionnaire.

Mean age was 51±13 years, median (Interquartile range, IQR) time since transplantation 65 (83) months, 57% were males and 19% had diabetes. The median (IQR) MIS was 3 (3). The MIS significantly and negatively correlated with almost all HRQOL domains analyzed, and this association remained significant or near significant in multivariate linear regression analysis for the log-transformed scores on Energy/fatigue (beta=-0.059 p< 0.001), Bodily pain (beta=-0.056 p=0.004), Physical functioning (beta=-0.029, p=0.072), Emotional well-being (beta=-0.024 p=0.077), Symptoms/problems (beta=-0.023 p=0.005) and Sleep domains (beta=-0.027, p=0.056) after statistical correction for age, gender, renal function, dialysis time, comorbidity and occupational status.

Malnutrition Inflammation Score is independently associated with different dimensions of health related quality of life in kidney transplanted patients.

There is retrospective evidence of a correlation between psychosis in multiple sclerosis (MS) however comorbidity of Psychosis in MS patients is a less frequent condition and the treatment of this condition seems to be hard and complex.

32 years old, male patient with MS had psychotic symptoms simultaneously with exacerbations of MS symptoms for three times in three years.

The first psychiatric episode was one year after he had the diagnosis of MS due to episodes of difficulty in walking and determination of demyelination plagues by MRI. Irritability, delusions of jealousness and persecutions, agitation, drug refusal were occurred simultaneously with the exacerbated symptoms of MS as right sided hemiparesia. He had been hospitalized and treated with olanzapine and high dose of corticosteroids. After this first episode he had two simultaneous episodes of psychosis with similar symptoms to previous one and exacerbations of MS with more severe symptoms as additional urinary incontinence. He was treated with olanzapine and corticosteroids in all episodes. The psychotic symptoms were remitted and the symptoms of MS were improved partially.

Psychosis is not a prominent feature of MS, occurring in 5% of cases. The relationship between lesions of the central nervous system and psychiatric illness has not been established yet. Some reports have implicated the contribution of acute demyelination to psychosis. In this case the simultaneous episodes of MS symptoms and psychosis suggest a common etiology. Prospective studies are required both about the common etiology and treatment.

Depression and anxiety are the commonest psychiatric disorder in patient with thyroid disorders but continues to be significantly under-recognized and under treated. As a result, it may affect quality of life.

The objective was to determine the prevalence of depression and anxiety among thyroid patients and their associates.

This is a cross-sectional study conducted in the Endocrinology Clinic in University Malaya Medical Centre. The patients were interviewed by using MINI International Neuropsychiatry Inventory (MINI) for diagnostic assessment. Socio-demographic and the clinical data were obtained by interviewing the patients and also from the case notes. Quality of life was assessed by using Short Form Health Questionnaires (SF-36).

A total of 160 subjects were recruited. Current prevalence of 9.4% for Major Depressive Disorder (MDD) and 22.5% for Anxiety Disorder (AD) were found using MINI. Lifetime prevalence was 17.5% for MDD and 27.5% for AD. Panic disorder was the commonest type of anxiety disorder (16.9%) followed by generalized anxiety disorder (11.3%), social phobia (4.4%), agoraphobia (2.5%) and obsessive compulsive disorder (1.9%). Having past history of depression or anxiety was highly significantly associated with MDD (p< 0.001, OR 276.6, 95% CI= 33.2-2306.9) and AD (p< 0.001, OR=16, 95% CI=4.9-51.6). The score for quality of life was lower in those with MDD and AD. It was more pronounced among MDD patients.

The prevalence of MDD and AD among patients with thyroid disorders should be recognised. In addition, patients with MDD and AD had poorer quality of life.

We review four patients who developed Dissociative Disorders (Dissociative Amnesia and Ganser Syndrome) on a background of stresses related to immigration.

Patients were investigated medically, psychiatrically and neuropsychologically and in part neuroradiologically.

Patients were adult males with Eastern or Central European background and no known previous psychiatric or medical illnesses. They immigrated to Germany or Canada and encountered several difficulties in the process of migration or adaptation to the new country. All developed severe psychiatric dissociative symptoms after objectively minor stresses, which occurred several years after their immigration to the new country of residence. Despite adequate treatment, their symptoms followed a chronic course. The patients’ neuropsychological profiles shared similarities, such as executive functioning deficits (e.g. limited cognitive flexibility) and impairments of emotional processing in addition to severe autobiographical amnesia.

We propose that stresses related to immigration and acculturation could trigger dissociative memory disorders in immigrants via a dysregulation of the hormonal stress responses, which is mediated by individual characteristics (cognitive flexibility, emotional processing abilities, language competence and cultural affiliations).

Ethnicity may influence treatment decisions and treatment quality in mental disorders. There have been suggestions of institutional racism in mental health services.

In this study we aimed to compare treatment quality between two groups: Greeks and immigrants and prove whether in our clinic, ethnicity is a significantly restricting factor of treatment quality. This study was conducted with all in-patients of Second Psychiatric Clinic University of Athens at Attikon Hospital between April and December 2008.

A total of 101 in-patients aged 16-56 years old, were studed. There were 73 Greeks and 18 immigrants. The diagnoses were schizofrenia:36(49,31%) for Greeks and 10(55,55%) for immigrants, and mood disorders:37(50,68%) for Greeks and 8(44,44%) for immigrants. We considered that treatment quality is composed of factors such as: days of hospitalization, number of psychiatric medicines used before-during and after hospitalization, doses of: conventional and atypical antipsychotics, SSRI'S, SNRI'S, and mood stabilizers used before-during and after hospitalization.

In this study ethnicity was not significantly associated with rates of polypharmacy during and after admition. There was a reduction of medication prescribed after admission in both groups. Immigrants had longer inpatient stays than Greek patients. We saw similar rates of antipsychotics used in both groups, but Greeks were more likely to take mood stabilizers and SSRI'S-SNRI'S. There were also higher rates of atypical antipsychotics than antipsychotics used in both groups.

Up until recently, Jewish circumcision was a taboo Jewish rite, with the upmost importance to Jewish identity. Lately, voices began to rise in Israel that questions the rite. It is a growing community of parents that did not circumcise their sons, and stood oppose to the status quo of circumcision.

We will examine Jewish circumcision in non religious society in Israel through the voices of mothers who did not circumcise their sons.

Qualitative constructivist research based on depth interviews of mothers who did not circumcise their sons and cross cultural literature review.

In most cases the mother initiated an emotional decision not to circumcise. The characteristics of these women were atheist, older than usual, very educated, Most of which grew up with high expectations to be successful financially and professionally, but chose to live a more “homey” lives with their main goal children upbringing.

We have found that the opposition to Jewish circumcision in Israel is a statement that goes against the devaluation of the primary dyad between a mother and her child. It is not an isolated event but a part of a broader conceptual believes that emphasizes more “feminine” values such as motherhood, breastfeeding, nature and ecology, as opposed to “muscular” values as culture, ritual ceremonies, financial wealth and militarism. The social change that is represented by the opposition to Jewish circumcision is a part of the individualism of society which emphasizes the importance of the processes within the family unit.

The main aim of this study was to determine the level of patient doctor relationship (PDRQ) and assess further the mental health needs of patients attending psychiatry department.

A cross sectional study.

Setting: Psychiatry Department of the Hamad Medical Corporation.

Subjects : A total of 1300 adult patients were approached and 1054 (81.1%) expressed their consent.

The main outcome measures of the study were 13-item patient doctor relationship questionnaire (PDRQ) score and other 11 items assessing what patients need from psychiatrists.

The mean age of the studied psychiatry patients was 38.6±13.4 years with a male female ratio; 1:1. There was a significant difference observed in terms of educational level, occupation, monthly house hold income, number of rooms and number of people living in a house (p< 0.001). Overall satisfaction level of Qatari and other Arab patients with psychiatrists was high because most of the items of the questionnaire were rated above 3.8. The psychiatry patients were very happy with the dedication (4.0±1.0) and availability of psychiatrists (4.0±1.1) for consultation. The three issues most important for the Qatari and other Arab patients were that the doctor should talk about their condition (63.5%), talks about the treatment options (65.9%) for final decision and provide symptomatic relief (62.4%).

The study findings revealed that patient satisfaction in psychiatry hospital care was good and the overall satisfaction level of patients with psychiatrists was high, especially for the dedication and the availability of psychiatrists.

The research ‘Depressive Turkish women in the Rijnmond Region’ was started to explore and describe the idiom of distress of the Turkish migrated women and to clarify diagnostic problems concerning their depressive disorder.

By means of a qualitative explorative research, first in a pilot of ten Turkish women, afterwards 20 Turkish women the presentation and the depressive complaints were investigated with the help of a bi-lingual diagnostic interview, Turkish-Dutch. The interview was developed in cooperation with Turkish psychiatrists/doctors.

Results will be discussed in the presentation. They clearly show that, at the first sight the idiom of distress is characterized by a range of somatic complaints. Clinicians who are insufficiently sensitive to cultural differences may not realize that these complaints may indicate a depressive disorder. Complaints of anxiety and agitation are just as frequent as the depressive complaints. To express their inner feelings the women use specific Turkish idiom.

According to ICD such cases should be classified as depressive disorders as well as generalized anxiety disorders. Because the range of complaints is so varied, these disordersmay be under-diagnosed in Turkish women.The diagnostic interview proved to be a very reliable instrument in diagnosing depressive-anxiety disorders in Turkish women. It will be translated in German, English and Turkish.